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BACKGROUND: Escalating demand for specialist health care puts considerable demand on hospital services. Technology offers a means by which health care providers may increase the efficiency of health care delivery. OBJECTIVE: The aim of this study was to conduct a pilot study of the feasibility, benefits, and drawbacks of a virtual clinic (VC) in the general surgical service of a busy tertiary center. METHODS: Patient satisfaction with current care and attitudes to VC were surveyed prospectively in the general surgical outpatient department (OPD; n=223). A subset of patients who had undergone endoscopy and day surgery were recruited to follow-up in a VC and subsequently surveyed with regard to their satisfaction (20/243). Other outcomes measured included a comparison of consultation times in traditional and virtual outpatient settings and financial cost to both patients and the institution. RESULTS: Almost half of the patients reported barriers to prospective use of VCs. However, within the cohort who had been followed-up in the VC, satisfaction was higher than the traditional OPD (100% as compared with 187/223, 83.9%). Significant savings in both time (P=.003) and financial costs to patients and the institution were found. CONCLUSIONS: For an appropriately selected group of patients, VCs offer a viable alternative to traditional OPD. This alternative can improve both patient satisfaction and efficiency of patient care.
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After the publication of this work [1] errors were noticed in the total protein loading controls for Figs. 1C, 2B, 3B and 4B.
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INTRODUCTION: Inaccuracy in Hospital Inpatient Enquiry (HIPE)/Casemix-based data has been reported as high as 26%. This results in financial waste and makes effective audit impossible. We aimed to develop a novel web-based outcome audit system. METHODS: A web-based online audit system, Patientsmate©, was developed using an integrated database system written in the programme language PHP. Data were inputted by the surgical team responsible for the patients care. A prospective comparison study of the new Patientsmate© and the standard HIPE systems, was performed over a 1-month period and involving two general surgical teams in April 2010. In addition, a Likert-scale based questionnaire was designed and hosted within the Patientsmate© system. A focus group of those clinicians directly involved in data accessing and input were then invited to complete the questionnaire in order to assess usability of the system. RESULTS: During the study period there were a total of 108 patients and 88 procedures. Our study confirms the accuracy of clinician derived data, with the Patientsmate© system more accurately recording number of patients (83% vs. 80.6%), number of procedures (85.2% vs. 68.1%) and hospital day case rate (52% vs. 47.1%). Inputting data using Patientsmate© for a single patient took 6-7 minutes. Of those using the system, 75% reported feeling comfortable after using it once only and 100% were satisfied with the layout of the online interface. CONCLUSION: The Patientsmate© system allows for increased accuracy in outcome-based data as compared with the HIPE system, facilitating audit, financial savings and the appropriate allocation of services.
Subject(s)
Databases, Factual , Internet , Medical Audit/methods , Adult , Diagnosis-Related Groups , Female , Focus Groups , Humans , Male , Programming Languages , Prospective Studies , Surveys and Questionnaires , User-Computer InterfaceABSTRACT
INTRODUCTION: Oestrogens can mediate some of their cell survival properties through a nongenomic mechanism that involves the mitogen-activated protein kinase (MAPK) pathway. The mechanism of this rapid signalling and its dependence on a membrane bound oestrogen receptor (ER), however, remains controversial. The role of G-protein-coupled receptor and epidermal growth factor (EGF) receptor in an ER-independent signalling pathway modulated by oestrogen was investigated. METHODS: ER-positive and ER-negative breast cancer cell lines (MCF-7 and SKBR3) and primary breast cancer cell cultures were used in this study. Cell proliferation was assessed using standard MTT assays. Protein and cAMP levels were detected by Western blotting and ELISA, respectively. Antigen localization was performed by immunocytochemistry, immunohistochemistry and immunofluorescence. Protein knockdown was achieved using small interfering RNA technologies. RESULTS: EGF and oestrogen, alone and in combination, induced cell proliferation and phosphorylation of MAPK proteins Raf and ERK (extracellular signal regulated kinase)1/2 in both ER-negative SKBR3 and ER-positive MCF-7 human breast cancer cell lines. Increased Raf phosphorylation was also observed in primary human breast cultures derived from ER-positive and ER-negative breast tumours. Oestrogen induced an increase in intracellular cAMP in ER-negative SKBR3 human breast cancer cells. Oestrogen-mediated cell growth and phosphorylation of MAPK was modified by the EGF receptor antagonist AG1478, the G-protein antagonist pertussis toxin, and the angiotensin II receptor antagonist saralasin. Knockdown of angiotensin II type 1 receptor (AT1) protein expression with small interfering RNA attenuated oestrogen-induced Raf phosphorylation in ER-negative cells. AT1 receptor was found to be expressed in the cell membrane of breast tumour epithelial cells. CONCLUSION: These findings provide evidence that, in breast cancer cells, oestrogen can signal through AT1 to activate early cell survival mechanisms in an ER-independent manner.
